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Carotid Artery Pseudo-occlusion: Does End-diastolic Velocity Suggest Need for Treatment?

Mount Sinai School of Medicine, Division of Vascular Surgery, New York, Jonathan.Bowman{at}mssm.edu

Jeffrey W. Olin, DO

Mount Sinai School of Medicine, Division of Vascular Surgery, New York

Victoria J. Teodorescu, MD

Mount Sinai School of Medicine, Division of Vascular Surgery, New York

Alfio Carroccio, MD

Mount Sinai School of Medicine, Division of Vascular Surgery, New York

Sharif H. Ellozy, MD

Mount Sinai School of Medicine, Division of Vascular Surgery, New York

Michael L. Marin, MD

Mount Sinai School of Medicine, Division of Vascular Surgery, New York

Peter L. Faries, MD

Mount Sinai School of Medicine, Division of Vascular Surgery, New York

Objective: We reviewed our institution’s experience with carotid artery pseudo-occlusion (CAPO), to investigate whether internal carotid artery (ICA) end-diastolic velocity (EDV) as measured by duplex ultrasonography, was a predictor of need for further intervention. Methods: From February 2003 to January 2008, 7478 patients underwent duplex ultrasonographic evaluation of their carotid arteries. Diagnosis of CAPO included the appearance of a narrow flow jet (string sign) on power doppler images, low velocities in the ICA and additional criteria listed below. Results: Ten patients (0.13%) were identified as having a CAPO. All patients were asymptomatic and had an EDV < 78cm/s. Occlusion or functional occlusion was identified in nine patients on contrast imaging studies. Eight of these patients were treated medically without neurologic complication on follow-up. Two patients were treated with interventions and were asymptomatic at follow up. The mean follow up for the entire group was 12 months. Conclusions: Although this is a low volume study, there is evidence to suggest that asymptomatic patients with low EDV in the setting of carotid artery pseudo-occlusion found of duplex, may be safely managed medically.

Key Words: carotid stenosis • duplex ultrasound • nonoperative treatment

This version was published on August 1, 2009

Vascular and Endovascular Surgery, Vol. 43, No. 4, 374-378 (2009)
DOI: 10.1177/1538574409331696


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